Prognostic scoring systems: which one is best?

Abstract

Purpose of review: In the initial evaluation of patients with community-acquired pneumonia, a number of important assessments are made, including that of the severity of the illness. This assessment will determine the appropriate site of care, diagnostic work-up, and choice of empiric antibiotics. A number of severity assessment tools have been developed and some of the recent findings are reviewed.

Recent findings: A number of studies of the efficacy of the individual scoring systems, as well as comparator studies, have been undertaken. A significant number of patients with community-acquired pneumonia in Pneumonia Severity Index classes I and II are admitted to hospital and several of these patients suffer complications. Clinical and social factors other than those contained in the scoring systems need to be taken into consideration when deciding about hospitalization of patients with community-acquired pneumonia. A number of studies of the efficacy of the various scoring systems in predicting 'severe pneumonia' have been undertaken, as well as studies of their accuracy in the sub-set of patients with pneumococcal infections and in the elderly.

Summary: The various scoring systems have reasonable sensitivity and specificity and their own strengths and weaknesses, but should always be used in association with good clinical judgment.